Poor urban populations, especially children, have been disproportionally affected by a striking increase in asthma morbidity and mortality. Among the pediatric population, adolescents bear unique psychosocial characteristics requiring tailored intervention to reduce asthma morbidity; however, there is minimal information on risk factors for asthma morbidity in this group. The current proposal is a continuation of Project 7 of the previous AAIDCC award. This project has 2 major aims: A) To test the hypothesis that increased asthma morbidity in inner city adolescents relates to the socioeconomic features of this environment which promote exposure and subsequent sensitization to unique allergens and irritants. Data from the first 97 patients in this study support this hypothesis: we find a strong correlation between asthma severity and the degree of sensitization to cockroach allergens which appears to be related to allergen exposure. B) Our second aim is to test the hypothesis that individually tailored, intense asthma management that combines education, environmental control, easy access to care and state-of-the-art medical intervention (SPECIAL ASTHMA CLINIC) will have higher impact in reducing asthma morbidity in moderate and severe adolescent asthmatics compared to a group-based interactive educational program (ASTHMA FAIRS). We propose, however, that the latter program can have significant impact in promoting asthma knowledge, a goal that may be adequate for patients with milder disease. Our project is enrolling 2 cohorts (150 per group) ranging from mild to severe disease and equally representing the African American and the Caucasian communities. In the first phase of the study, subjects undergo extensive evaluation to determine asthma severity. In addition, allergen sensitization and socioeconomic, psychosocial and access/quality of care aspects are being determined. Finally, detailed environmental assessment including quantification of allergens in house dust samples is performed. These data will allow us to test our first hypothesis and to further establish the risk factors for asthma morbidity in adolescents that we have preliminarily identified. In the second phase of the study, Cohort 1 participates in 2 Asthma Fairs over a period of 1 year and is observed for l year to assess improvement in asthma knowledge and, for the moderate/severe asthmatics (N=50), in asthma morbidity. The moderate/severe subjects of Cohort 2 (N=50) will be enrolled in a Special Asthma Clinic for a minimum of 2 years. Again, they will be followed closely to monitor all aspects of asthma morbidity, as in Cohort 1. Comparison between the moderate/severe asthmatics in the 2 Cohorts will be made after one year of follow-up. Further, comparisons between baseline and post intervention will be made separately for the mild and the moderate/severe subjects in Cohorts 1 and 2. We anticipate that the results of this study will have major impact in our understanding of the causes of increased morbidity from asthma in the inner city and will pave the way for cost-effective intervention that can be implemented nationwide.